The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery

Taddio, Anna; Alderman, Leslie; Freedman, Theodore; McDowall, T. W.; McMurtry, C. Meghan; MacDonald, Noni E.; deVlaming-Kot, Christene; Alfieri-Maiolo, Angela

doi:10.1093/pch/pxz021

Cited by 22 publications

(25 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results are consistent with prior research demonstrating that CARD™-informed alterations in the school immunization delivery process are possible and can have positive effects on public health staff perceptions of clinic success [ 5 , 6 ]. In particular, staff reported satisfaction with changes in the physical set-up and flow of students to reduce cues of fear.…”

Section: Discussionsupporting

confidence: 90%

“…Engaging students as active partners during immunization and coaching them on their preferred coping strategies may represent a significant change in perspective for many nurses who are accustomed to leading interactions with students and directing them to use nurse-selected coping strategies. This finding contrasts with the experience in Niagara, whereby student involvement was perceived as a major benefit by both nurses and students [ 5 , 6 ]. This finding represents an opportunity for further evaluation of staff perceptions of what is intended by a person-centred approach to immunization delivery as well as student perceptions of being included [ 3 ].…”

Section: Discussioncontrasting

confidence: 62%

“…In a controlled cluster trial conducted in Niagara, a small urban region of Ontario, Canada, CARD™ reduced high levels of fear and dizziness in grade 7 students and was so valued by the students and public health nurses that all schools in that region are now using this program [ 5 , 6 ]. In the current project, we explored how to customize CARD™ before scaling the implementation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Negative experiences with school-based immunizations can contribute to vaccine hesitancy in youth and adulthood. We developed an evidence-based, multifaceted and customizable intervention to improve the immunization experience at school called the CARD™ (C-Comfort, A-Ask, R-Relax, D-Distract) system. We evaluated the feasibility of CARD™ implementation for school-based immunizations in Calgary, Canada. Methods In a mixed methods study, two Community Health Centres providing immunization services, including 5 schools each with grade 9 students (aged approximately 14 years), were randomized to CARD™ or control (usual care). In the CARD™ group, public health staff and students were educated about coping strategies prior to immunization clinics. Clinics were organized to reduce fear and to support student’s choices for coping strategies. Public health staff in the CARD™ group participated in a focus group discussion afterwards. We sought a recruitment rate of 80% for eligible schools, an external stakeholder focus group (e.g., school staff) with 6 or more individuals, 85% of individual injection-related data acquisition (student and immunizer surveys), and 80% absolute agreement between raters for a subset of data that were double-coded. Across focus groups, we examined perceptions of acceptability, appropriateness, feasibility and fidelity of CARD™. Results Nine (90%) of eligible schools participated. Of 219 students immunized, injection-related student and immunizer data forms were acquired for 195 (89.0%) and 196 (89.5%), respectively. Reliability of data collection was high. Fifteen public health and 5 school staff participated in separate focus groups. Overall, attitudes towards CARD™ were positive and compliance with individual components of CARD™ was high. Public health staff expressed skepticism regarding the value of student participation in the CARD™ system. Suggestions were made regarding processes to refine implementation. Conclusion While most outcome criteria were satisfied and overall perceptions of implementation outcomes were positive, some important challenges and opportunities were identified. Feedback is being used to inform a large cluster trial that will evaluate the impact of CARD™ during school-based immunizations. Trial registration The trial is registered at ClinicalTrials.gov (NCT03948633); Submitted April 24, 2019.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…There was satisfaction with the KT intervention and support for continuing it beyond the project. There was no evidence of an impact on vaccination rate (19,20).…”

Section: Methodsmentioning

confidence: 91%

Overview of a Knowledge Translation (KT) Project to improve the vaccination experience at school: The CARD™ System

Taddio

McMurtry

Bucci³

et al. 2019

Paediatrics &Amp; Child Health

Self Cite

View full text Add to dashboard Cite

Background Students experience fear, pain, and fainting during vaccinations at school. While evidence-based interventions exist, no Knowledge Translation (KT) interventions have been developed to mitigate these symptoms. A multidisciplinary team—the Pain Pain Go Away Team—was assembled to address this knowledge-to-care gap. This manuscript provides an overview of the methodology, knowledge products, and impact of an evidence-based KT program developed and implemented to improve the vaccination experience at school. Methods We adapted knowledge and assessed the barriers to knowledge use via focus group interviews with key stakeholder groups involved in school-based vaccinations: students, nurses, school staff, and parents. Next, we developed project-specific goals and data collection tools and collected baseline data. We then created a multifaceted KT intervention called The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract) to provide a framework for planning and delivering vaccinations using a student-centred approach. Selected KT tools from this framework were reviewed in additional focus groups held in all stakeholder groups. The multifaceted KT intervention was then finalized and implemented in stages in two projects including grade 7 students undergoing school vaccinations and impact on student outcomes (e.g., symptoms of fear, pain, dizziness) and process outcomes (e.g., utilization of interventions that reduce student symptoms, vaccination rate) were assessed. Results Participants reported that improving the vaccination experience is important. Based on participant feedback, an evidence-based multifaceted KT intervention called The CARD™ System was developed that addresses user needs and preferences. Selected KT tools of this intervention were demonstrated to be acceptable and to improve knowledge and attitudes about vaccination in the stakeholder groups. In two separate implementation projects, CARD™ helped grade 7 students prepare for vaccinations and positively impacted on their vaccination experiences. CARD™ improved vaccination experiences for other stakeholder groups as well. There was no evidence of an impact on school vaccination rates. Conclusion We developed and implemented a promising multifaceted KT intervention called The CARD™ System to address vaccination-associated pain, fear, and fainting. Future research is recommended to determine impact in students of different ages and in different geographical regions and clinical contexts.

show abstract

“…We used similar procedures and instruments as in our prior studies [12][13][14][15][16][17]. First, students independently completed attitude surveys about immunization pain and fear and acceptance of immunizations.…”

Section: Materials and Proceduresmentioning

confidence: 99%

Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School

et al. 2020

Self Cite

View full text Add to dashboard Cite

Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C—Comfort, A—Ask, R—Relax and D—Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre–post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations.

show abstract

The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery

Cited by 22 publications

References 16 publications

Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial

Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial

Overview of a Knowledge Translation (KT) Project to improve the vaccination experience at school: The CARD™ System

Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School

Contact Info

Product

Resources

About